Provider Demographics
NPI:1790111938
Name:CHAN, QIANTING (LAC)
Entity Type:Individual
Prefix:
First Name:QIANTING
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6070 STEVENSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-5250
Mailing Address - Country:US
Mailing Address - Phone:510-996-8446
Mailing Address - Fax:
Practice Address - Street 1:6070 STEVENSON BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-5250
Practice Address - Country:US
Practice Address - Phone:510-619-8484
Practice Address - Fax:855-838-5878
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14776171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist